How the dyads of heart failure patients and their informal caregivers cope with the disease process: a qualitative synthesis

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Heart failure (HF) is a debilitating and progressive condition requiring consistent self-care by patients and their caregivers. Understanding the dyadic coping experience is crucial to inform the development of effective self-care interventions. Existing reviews focused on coping experience of patients or informal caregivers separately, without considering dynamic interaction between patients and caregivers. Purpose This review aimed to synthesize the qualitative studies to understand how patients and their caregivers interact and jointly cope with HF. Methods A systematic literature searching was conducted in nine electronic databases from inception to 11 June 2022. Manual searching of the reference list of relevant articles was also conducted. Articles were eligible if they focused on exploring the dyadic coping experience of HF patient-caregiver dyads aged 18 years or older. The Critical Appraisal Skills Programme tool for qualitative studies was used to assess the methodological quality of included articles. Thematic synthesis was adopted to synthesize the findings. Results Thirty articles were included in the review. Eleven articles were rated as high quality and nineteen as moderate quality. Three analytical themes emerged from the findings: (1) challenges in their changing and shared life experience, (2) conditions shaping dyadic coping experience, and (3) evolving dyadic coping strategies from the illness experience (Figure 1). Patients’ progressive and debilitating disease conditions disrupted the shared lives of the dyads, consequently causing a series of stressors for both to cope with. Dyadic coping of HF is influenced by the interpersonal context (i.e., congruence of illness perception, dyadic relationship and interaction, dyadic coping capabilities) and social context (i.e., professional and informal input). During the coping process, HF dyads utilized constructive or destructive methods of adjusting relationship boundaries, transforming patterns of dyadic coping and regulating emotion in a dyadic context. Besides, the strategies of amplifying positive changes and seeking meaning were critical for dyads to normalize HF in their lives. Conclusion HF imposed multiple stressors on the shared life of the dyads. Under the influence of interpersonal and social context, patients and caregivers co-regulated dyadic coping strategies to respond to dyadic stress, either adaptively or maladaptively. A relationship-focused dyadic approach is needed to optimize the synergy in the dyadic coping process and support dyads to cope with HF.